Even With $100 Million, WHO Says It Will Take Months To Control Ebola

A health worker cleans his hands with chlorinated water before entering an Ebola screening tent at the Kenema Government Hospital in Sierra Leone. More than 300 Sierra Leoneans have died of the disease.

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Originally published on August 15, 2014 7:50 pm

When public health officials warn that it's likely to take many months to bring the Ebola outbreak in West Africa under control, it's not because they're facing a single huge challenge.

"If there was just one solid, large chunk we could slice out, we would," says WHO spokeswoman Nyka Alexander, at the agency's regional coordination center in Conakry, Guinea. "But it's so many little things that add up to the outbreak."

In its attempt to bring the Ebola outbreak under control, The World Health Organization has announced a $100 million dollar plan.

Money is already flowing in, but it turns out that it's much more challenging to respond to the slow burn of an epidemic than to a natural disaster – where sending in rescue teams or delivering water are obvious first steps.

Nonetheless, there are some obvious needs in West Africa — for example, providing a constant supply of protective clothing for the doctors and nurses who risk their lives in makeshift hospitals. WHO is also flying in medical supplies and helping coordinate the logistics of getting food to areas that have been placed into forced isolation.

Neighboring countries are being targeted as well. WHO is helping 11 nations gear up for a possible spread of the epidemic, with offers of training as well as 500 sets of protective gear for each country, Alexander says.

More than half the money that WHO hopes to collect from the international community is supposed to flow to the governments of Liberia, Sierra Leone and Guinea to bolster their teetering health care systems. Additional funds will go to international organizations that provide expertise and supplies.

Another daunting task it to get the right people – and enough of them – to cope with the outbreak. And it's not just doctors and nurses.

"A lot of this response is going to have to be local," says Dr. Trish Perl, chief epidemiologist at Johns Hopkins Medicine. "You may not be able to walk in and just say, 'OK, who in this village has Ebola?' That may not be something that's culturally acceptable."

Advisers can train local people how to do that critical job — in fact some of those trainers are from the U.S. Centers for Disease Control and Prevention.

Experts from the U.S., Europe and other nations in Africa can set up the critical systems needed to track the epidemic — identifying where the active cases are. Many cases of the disease aren't being tracked at all.

"A lot of these [cases] are probably getting logged with paper and pencil, if they're getting logged at all," Perl says. "We don't really know the magnitude of the epidemic because they don't have a well-defined surveillance system in place."

A surveillance system may seem like bean counting while a disease is raging, but Perl says it's actually essential for tracking the disease, identifying flare-ups and ultimately bringing it under control by isolating infected people.

ideally, that system should stay in place after the current outbreak is snuffed out ... because Ebola and other diseases aren't going away.

"Whatever WHO does in a country needs to leave something very substantial behind, so it's not just a matter of doing the same thing time and time again," says Dr. Nils Daulaire, until recently the U.S. representative on the WHO Executive Board.

Even in an emergency, it's important to repair badly broken health care systems, like those in West Africa.

Of course that's more easily said than done. About a decade ago, some West African nations received international assistance to prepare for a possible outbreak of avian flu.

"When avian influenza ended, when the threat went away, these systems atrophied," says Dr. Fred Hartman, who's with a nonprofit called Management Sciences for Health. "Resource-scarce countries have many demands on their resources. Malaria can flare up or cholera, or something else."

So it takes a sustained response, not just one-time aid projects, to strengthen these health care systems — which had been crippled by civil wars and are only gradually being rebuilt.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

As the World Health Organization tries to bring the Ebola outbreak under control, it's announced a plan that would cost $100 million. Promises of funding help have been flowing in. NPR's Richard Harris has this story about how the WHO will spend the money.

RICHARD HARRIS, BYLINE: It turns out that it's much more challenging to respond to the slow burn of an epidemic than it is to a typical natural disaster. When I asked WHO spokeswoman Nyka Alexander in Conakry, Guinea what's the biggest single challenge right now, she had no easy answer.

NYKA ALEXANDER: If there was just one solid large chunk that we could just slice out, we would. But it's so many little things that add up to the outbreak.

HARRIS: There's obvious needs like providing a constant stream of protective clothing for the doctors and nurses who are risking their lives in the makeshift hospitals and medical supplies - it's getting food to areas that have been placed into forced isolation - it's helping neighboring countries prepare in case the disease crosses more borders. WHO is working on all those problems. More than half of the money WHO is collecting is supposed to flow to the governments of Liberia, Sierra Leone and Guinea to bolster their teetering healthcare systems. More goes to international organizations that provide supplies and expertise. Doctor Trish Perl is chief epidemiologist at Johns Hopkins Medicine.

TRISH PERL: You need expertise from the West to support some of this, but a lot of this response is going to have to be local. You know, you may not be able to walk in and just say OK, so who in this village has Ebola? That may not be, you know, something that's culturally acceptable.

HARRIS: Advisors can train local people how to do that critical job. And in fact, some of those trainers are from the U.S. Centers for Disease Control and Prevention. Experts from the U.S., Europe and other nations in Africa can also set up the critical systems that are needed to track the epidemic. Many cases of the disease aren't being tracked at all.

PERL: A lot of these people are getting logged probably on papers and pencils, if they're getting logged at all. You know, we don't even really know the magnitude of the epidemic just because they don't have a well-defined surveillance system in place.

HARRIS: A surveillance system may seem like bean-counting while a disease is raging out of control, but Perl says it's actually essential for tracking the disease, identifying flare-ups and ultimately bringing it under control by isolating infected people. And ideally that system should stay in place after the current outbreak is finally snuffed-out because Ebola and other diseases aren't going away. Doctor Nils Daulaire, who was until recently the U.S. representative on the WHO executive board, says even in an emergency it's important to repair badly broken healthcare systems like those in West Africa.

NILS DAULAIRE: Whatever WHO does in a country needs to leave something very substantial behind so that it's not a matter of just going back and doing the same thing time and time again.

HARRIS: Of course this is more easily said than done. Doctor Fred Hartman from a nonprofit called Management Sciences for Health says not many years ago some of these West African nations got international assistance to prepare for a possible outbreak of avian flu.

FRED HARTMAN: When avian influenza ended - when the threat went away, these systems atrophied because resource-scarce countries have many demands on their resources, you know. Malaria can flare up or cholera or something else.

HARRIS: So it takes a sustained response, not just one-time aid projects to strengthen these healthcare systems, which have been crippled by civil wars and are only gradually being rebuilt. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.